61694D - Fisher

CAMA / DREDGE & FILL
GENERAL PERMIT
Previous permit #
New ❑Modification []Complete Reissue ❑Partial Reissue
Date previous permit issued
rized by the State of North Carolina, Department of Environment and Natural Resources
07
Coastal Resources Commission in an area of environmental concern pursuant to I SA NCAC
�nt NamQe-6fJ-f/�"� l �� r
[]jtules a hed.
Project Location: County
s tl-1 ��a u r''V
Street Address/ State Road/ Lot #(s)
q
Zi State r-' ZIP
#)7 {l iFax # ( )
Subdivisign
ized Agent
City r w r%5 ZIP �I
d ❑ CW ❑ EW .[].PTA ❑ ES ❑ PTS
Phone # ( ) Basin
❑ ❑ ❑ Ill ❑ OEA J HHF IH N/A
/ ,Riive�rr
Adj. Wtr. Body MO // �'�=�.�yC- ". nat
❑ PWS: ❑FC:
yes /. nQ PNA re)/ no Crit.Hab. yes
Closest Maj. Wtr. Body �✓1
A Project/ Activity
lock) length__
1(s)-
length
umber
ead/ Riprap length
vg distance offshore
iax distance offshore
channel
ubic yards
imp
)use/ Boatlift
B d zing I
ne Length _
DO
not sure yes
igs: not sure yes
>rium: n/a yes
yes
Attached: yes '- no
'7 ' 717�
(Scale: //`,
ling permit may be required by: ` � r// V lilt I / ❑ See note on back regarding River Basin

iplicant: go � ew-! Permit #:
w o4
ite: 4 —
scribe below the HABITAT disturbances for the application. All values should match the name, and units of measurement
nd in your Habitat code sheet.
TOTAL Sq. Ft.
FINAL Sq. Ft.
eet
FINAL Feet
(Applied for.
(Anticipated finalr.
(Anticipated final
�itat Name DISTURB TYPE
Disturbance total
disturbance.
7(Appliedfor.
ce
disturbance.
Choose One
includes any
Excludes any
es
Excludes any
anticipated
restoration
ted
restoration and/or
restoration or
and/or temp
or
temp impact
temp impacts)
impact amount)
temp impacts)
amount)
1i>
Dredge ❑ Fill ❑ Both ❑ Other"ru
Dredge ❑ Fill ❑ Both ❑ Other ❑
COMPLETE•N COMPLETE THIS SECTIONON DELIVERY
■ Complete items 1, 2, and 3. Also complete A. S ature
item 4 if Restricted Delivery is desired. ❑ Agent
X
■ Print your name and address on the reverse ❑ Addressee
so that we can return the card to you.
B. Received by (Printed N e) C. Date of Delivery
■ Attach this card to the back the mailpiece, ^/4s 61j950
or on the front if space permits. (,
1. Article Addressed to: D. Is delivery ress d' m item 1? ❑ Yes
If YES, a 81y very a low: ❑ No
7 �C"'6 50-� Fl�'
- N
s
boo C df4?-
nf 3. service T �1 S d
al v c Certified Mail cprsss Mail
< Registered ❑ Return Receipt for Merchandise
��� ❑ Insured Mail ❑ C.O.D.
4. Restricted Delivery? (Extra Fee) ❑ Yes
2. Article Number (7 012 1640 0000 1119 9 9 7 0
Transfer from service label)
Ps Form 3811, February 2004 Domestic Return Receipt 102595-02-M-1540
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑

Bank of America
5830
:ONTRACTORS, LLC 08-03
ACH R/T 053000196
66 t 9/530 NC
58754
367-2159
kROLD CT.
TAD, NC 28443
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DOLLARS
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000684743738n'
AUTHORIZED SIGNATURE

T
ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
(FOR A PIER/MOORING PILINGSBOATLIFTBOATHOUSE)
I hereby certify that I own property adjacent to kv F. 's
(Name of Property Owner)
property located at /1g 1 &"
(Lot, Block, Road, etc.)
on , in , N.C.
(Waterbody) (Town and/or County)
Applicant's phone #:
l e/ a 7621 Mailing Address: / `7 L (, zu'r /W -
1V ew Ate, /'A /g93$
He has described to me, as shown below, the development he is proposing at that location, and, I
have no objections to his proposal. I understand that a pier/mooring pilings / boatlift / boathouse
must be set back a minimum distance of fifteen feet (15) from my area of riparian access unless
waived by me. (If you wish to waive the setback, you must initial the appropriate blank
below.)
�-- I do not wish to waive
I do wish to waive that setback requirement.
DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT:
(To be filled in by individual proposing development)
--------------------------------------------------------
(Information for Property Owner Applying
for Permit)
Mailing Address
P "'o Rt
(Riparian Property Owner Information)
ia _ e ,_-v
Signature
/V e4,0 Ar- /'/-T 18 738
(1;tv/Qtnt,-/7;n

N.C. DIVISION OF COASTAL MANAGEMENT
AGENT AUTHORIZATION FORM
Date �- 1 l / 3
Name of Property Owner Applying for Permit:
kvbeP-T �F- F1,4E'R,
Mailing Address:
1904� ya, aR-th AC5,CW
Ncto RoEE- I P14, I c,4q3?'
Z lg- 7qy - 7�21
I certify that I have authorized (agent) 91t 1411� `�I to act on my
l
behalf, for the purpose of applying for and obtaining all CAMA Permits necessary to
install or construct (activity) -� ) o
at (my property located at) f / �51 1vL,,r- ((
This certification is valid thru (date) 1- ` 1- l
71 r
It
Property Owner Signature Date

CAMA / DREDGE & FILL
GENERAL PERMIT
Previous permit #
New Modification Complete Reissue - Partial Reissue
Date previous permit issued
As authorized by the State of North Carolina, Department of Environment and
Natural Resources
IT / C "• '
and the Coastal Resources Commission in an area of environmental concern pursuant
to I SA NCAC
Applicant Name_ `-�'t t "� l ' /' 1.1. :?�
i- 'Rules shed.
Project Location: County._____
Address---- I >' U' % llwv+a
Street Address/ State Road/ Lot #(s)
- ire State r_ ( 4 -._
NG._ S . ZIP City
_ _
, ......_..%..,
Phone # �1�/' 7 Fax #
Subdivisit3n _
�°t8 L.G .. _ .Y r'
Authorized Agentif ��Li.Li.:�- ......
City' a,. t•<-� :< _. ZIP
_ .... - ..
Affected CW )qEW A PTA ES PTS
Phone # ( ) River Basin
AEC s): OFA HHF IH USA WA
(
Ad . d Wtr. So
( y - hat /mar►../unkn;
PWS: FC :
yes iO "o PHA 4es / no Crit.Hab. yes /ifo;
`
Closest Maj. Wtr. Body
._.IRW:
Type of Project/ Activity r : z i•.';' t 7,
_ — (fie:
Pier (dock) length "
Platform(s)
Finger pierfsi
Groin length v Y.
number r ��
Bulkhead. Riprap length
avg distance offshore
max distance offshore
Basin. channel \ : ' • 'r r
cubir- yards
Boat ramp
Boathousei Boadift
Reach B dyzi
J fng
Other
'►/• fr-"`
i
_ .__ �
Shoreline LenEth
=�r�
j
SAV: not sure yes �ryna
Sandbags: not sure yes J •
f '
Moratorium: n/a yes
i
i
PFIOLOS: yeS no�.,
Waiver Attached: yes % rior_'
A building permit may be required by:
See note on back regarding River Basin rules.
Notes( Special Conditions